Suffering a debilitating work-related injury or occupational disease that requires a worker to stop working is devastating emotionally and financially for the affected individual and his or her family. Disabilities, while affecting millions (almost two million in Ontario alone), are hard to predict and frequently come on suddenly and without warning. Long-term disability benefits (LTD), of which a number are offered through the Ontario government and private programs, are the best way to minimize the loss of income and are most commonly seen as a group benefit provided by many employers, as well as through private insurers. LTD benefits generally cover disabilities arising from any accident or illness, regardless of where or how contracted. However, collecting long-term disability and WSIB can be a difficult task.
One particular form of LTD coverage, Workplace Safety and Insurance Board (WSIB) benefits, on the other hand, must be the direct result of an accident or injury experienced on the worksite. The WSIB claim requires medical documentation requirements and may lead to compensation in the form of a pension or a lump sum option. Compensable benefits are subject to eligibility criteria and an assessment duration. The process may require a worker to submit medical evidence and undergo a functional capacity evaluation to determine if the impairment is permanent or partial. The intersection of standard long-term disability and WSIB benefits can be quite confusing for an injured worker, and he or she may not know which benefits to request, or how receiving one can impact the right to collect the other. A discussion related to the ability of a disabled worker to collect both LTD and WSIB benefits for the same accident or illness will follow below.
Differences Between Long-Term Disability and WSIB Benefits
As noted above, individuals working in Ontario have access to several types of disability coverage, as well as WSIB benefits (a program most employers are required to join). WSIB benefits are regulated by statute in terms of a person qualifying, the income loss amount, and the duration of benefits. Once a workplace injury occurs, a claim must be completed immediately, and the employer must arrange a medical assessment to determine the next steps. In addition to lost income, WSIB benefits also cover medical expenses.
LTD benefits are offered for accidents or illnesses that typically occur outside the workplace and involve disabling impairments that prevent a person from performing his/her daily work functions. While LTD policies cover a large portion of a disabled individual’s lost wages, they do not directly pay for medical expenses. This is an important consideration when determining how far this money will go and with which program to file a claim if more than one option is available. Most long-term disability policies will pay out for two years, though it is possible to collect long-term disability until the age of retirement at 65. In any LTD claim, whether it is through the WSIB program or a private policy, the key question is always how disability is defined because it varies by the program, and qualifying for one does not guarantee eligibility for another.
Can You Collect Both Long-Term Disability and WSIB?
Most group LTD policies include conditions that limit the receipt of disability benefits from another source. In other words, it is not ordinarily possible to collect full long-term disability benefits from both a private policy and WSIB. Co-ordination clauses are standard in group policies and specifically reduce the benefits paid in correlation to disability benefits received elsewhere. The type and extent of the offset vary by the language in the LTD contract, and in fact, many policies require injured workers not only to apply for WSIB benefits as a condition of collecting long-term disability but also to appeal if the initial claim is denied. Complications typically arise when it becomes unclear if a workplace injury caused another condition to emerge soon after, or whether the new medical condition is independent of the earlier medical issues. An experienced LTD lawyer can assist with properly submitting a claim, determining which disability programs to apply to, and appealing any denials of coverage.
Speak with a Lawyer About Long-term Disability and WSIB
Experiencing a disabling event of any kind is a hard adjustment to make. The financial stresses of not being able to work only adds to the physical and emotional difficulties of living with a debilitating condition. Securing the disability benefits you need to find equilibrium requires an experienced disability lawyer to guide you.
